Provider Procedural Manual - The Health Plan

PROVIDER PROCEDURAL MANUAL 2014The Health Plan Quality Management ProgramHEDIS® Coding and Documentation HintsOBESITY AND TOBACCO USE INCREASE RISK FORCARDIAC AND DIABETIC DISEASETobacco Abuse 305.1- Per the CDC, “Smoking harms nearly every organ of the body, causingmany diseases, and affecting the health of smokers in general. Quitting smoking has immediateas well as long-term benefits....” For more information on the harmful effects of smoking,smokeless tobacco, and secondhand smoke, visit: http://www.cdc.gov/tobacco.* We encourage you to assess all patients for tobacco use and to counsel regarding cessation.Overweight (BMI 25-29---V85.2-V85.25)Obesity (BMI 30-39---V85.3-V85.39Morbid obesity (BMI 40+ ---V85.4-V85.45)* Record a BMI and consider a lipid profile, nutrition counseling, and activity counseling.For more information on helping your overweight and obese patients, visit:http://www.cdc.gov/obesity.CHILDHOOD OBESITY – PCP and PEDIATRICIAN OVERSIGHTChildhood obesity is a growing epidemic which can lead to an early onset of hypertension anddiabetes. In light of this major health issue, we encourage our PCPs to obtain a BMI percentile;and to assess the nutritional and activity status of the children in your practice. We alsoencourage you to counsel the child and their parents regarding how they can choose wisely andcombat obesity. This should be done by the child’s PCP of record, whether that is a FamilyPractitioner or a Pediatrician.A gender-specific (BMI) body mass index-for-age percentile chart is available athttp://www.cdc.gov/growthcharts; by visiting www.healthplan.org | Members | Health &Wellness | Prevention & Wellness Resources or by calling the QI department at 740-695-7659.BMI percentile: V85.5 (Body Mass Index; Pediatric)Nutrition Counseling: V65.3 (Counseling or referral for nutrition education; discussion ofcurrent nutrition behaviors such as eating habits and dieting behaviors; checklist indicatingnutrition was addressed; educational materials given on nutrition)Physical activity counseling: V65.41 (Counseling or referral for physical activity; discussion ofcurrent physical activity behaviors such as exercise, participation in sports activities, and anexam for sports participation; checklist indicating physical activity was addressed; educationalmaterials given on physical activity)Section 8 / Page 59